Is ibuprofen (Nonsteroidal Anti-Inflammatory Drug (NSAID)) safe for breastfeeding women?

Ibuprofen is Safe During Breastfeeding

Ibuprofen is explicitly safe for breastfeeding women and can be used without interrupting nursing or waiting periods between doses and breastfeeding. 1, 2

Evidence-Based Safety Profile

The 2020 Association of Anaesthetists guidelines definitively list ibuprofen as compatible with breastfeeding, with no requirement to interrupt nursing or express and discard breast milk. 1 This recommendation is reinforced by multiple international guidelines that confirm both ibuprofen and other NSAIDs transfer into breast milk in minimal amounts that pose no risk to the infant. 2, 3

Breastfeeding can occur immediately after taking ibuprofen without any waiting period. 2

Clinical Recommendations

Dosing Strategy

• Use the lowest effective dose for the shortest duration needed 1, 2
• Multimodal analgesia combining ibuprofen with paracetamol (acetaminophen) is encouraged to minimize the need for opioid medications 1, 2
• Short-acting NSAIDs without active metabolites like ibuprofen are preferred for long-term treatment 4

Practical Advantages

• Ibuprofen has the most extensive safety data among NSAIDs during lactation 2, 5
• It allows mothers to maintain their ability to care for their infants without sedation concerns that accompany opioid use 1, 5
• No special monitoring of the infant is required 2

Special Considerations for Young Infants

While ibuprofen remains safe across all age groups, extra caution should be exercised when the infant is less than 6 weeks of age (corrected for gestational age) due to immature hepatic and renal function. 1, 2 However, this caution applies more significantly to opioids than to NSAIDs like ibuprofen. 5

The order of medication sensitivity decreases as: preterm infants > neonates > young infants. 2

Common Pitfall to Avoid

Do not unnecessarily interrupt breastfeeding or express and discard milk after taking ibuprofen. 2 This outdated practice has no scientific basis and can undermine breastfeeding success. The amount of ibuprofen transferred to breast milk is significantly less than pediatric therapeutic doses and poses no risk to the nursing infant. 2, 3

Alternative Safe Options

If ibuprofen is contraindicated or ineffective:

• Paracetamol (acetaminophen) is equally safe and compatible with breastfeeding 1, 2, 6
• Other NSAIDs including diclofenac, naproxen, and ketorolac are also safe alternatives 1, 5, 7
• Non-pharmacological approaches like physical therapy and heat/cold therapy can be used 2